Continuous Health Care Advice (Assessment structure)

devonian20

Hello everyone
Hoping someone out there can help.  My Dad is in a specialist care home for Dementia sufferers.  My mum applied for CHC (using a professional company for support). The report has just come back and has found Dads level of need does not meet the threshold to be taken forward to full panel assessment.

My question is largely around the structure of the assessment.  In my eyes, the assessment is about my Dads level of needs purely.  In the report findings, numerous occasions suggest Dad's needs are catered for by the care home and therefore his level was judged on that.  My argument would be that his environment is irrelevant.  For example:

In the Mobility section, while Dad was in his own home he had several falls.  In the Care home he hasn't had any. The report suggested "Within his current care home his falls risk seems to be effectively managed due to the environment". To me this reads that if Dad were still in his own home he would likely qualify for a higher level of need and therefore this assessment is about his environment not his need.  If anything, he needs to be in the Care Home setting to lessen the likelihood of injury and that is a sign CHC is needed.

Under Communication, the report states "his responses provide insight for carers to interpret his needs" and "many of his needs can be interpreted by care staff".  This says to me that Dad clearly needs to be in the Care Home environment to have his needs met by professional carers?

I may be wrong - is the current environment of the person being assessed relevant to their level of need?  I feel if Dad were in his own home, the report findings would be different.

Thank you!

Myci85

No advice sorry, but my mum has recently found similar difficulties with the assessment. Her OH has non malignant brain tumours, diagnosed many years ago but now severely impacting him. 
Six months ago she would have answered that he was having multiple falls, that he was getting agitated and becoming violent when they were trying to provide care etc (not sure on the exact wording of the questions), but since then he has further deteriorated and now is bed bound and 'compliant' because he is just lying there and barely with it. But because they were coping better 6 months ago in caring for him they didn't do the assessment then, and now they have been told they don't qualify for help. 

Savvy_Sue

There is a well-worn phrase from those who have faced such struggles (and their legal advisers). 

"A well-managed need is still a need."

If you google that phrase you'll get some useful links. 

I think my relative's assessment was more accurate: they don't qualify for CHC, which didn't surprise me, but they did score a high need for risk of pressure sores, and another for nutrition. Both of these 'needs' are well-managed within the home, but the risks of developing sores or losing another shedload of weight both remain. 

elsien

The CHC assessment takes into account his needs at the time of the assessment. If he was falling previously, but isn’t now, then it would be noted more as background information rather than a current need. 

Being in the care home in and of itself won’t stop him from falling; just to give examples it may be that his physical health has improved so he is less wobbly , or it may be that as his dementia increases he might be trying to stand up less and so simply less prone to falls because he’s not moving around.

With the communication example, if he was at home then the assessment would simply instead say his needs are interpreted by his wife and visiting carers, because his communication will be the same where ever he is and the important bit is that people understand  and anticipate his needs, whoever the carers are.

Having dementia in and of itself does not qualify people for full CHC funding. Most people in specialist nursing homes only get the FNC top up not the full funding unless their care is particularly complex in some way. 

There is the appeals mechanism, but it needs evidence. and sometimes the evidence isn’t there because care home recording can be quite poor.

itsthelittlethings

Continuing Healthcare funding is for people whose needs are purely health in my understanding ie they really need to be cared for in a hospital long term. This would be things like PEG feeds (?).

itsthelittlethings

Do you agree that "Within his current care home his falls risk seems to be effectively managed due to the environment" and "his responses provide insight for carers to interpret his needs"?

It sounds to me that they have done a review of the home for your mum’s money as they obviously haven’t got her CHC.

Albermarle

itsthelittlethings said:

Continuing Healthcare funding is for people whose needs are purely health in my understanding ie they really need to be cared for in a hospital long term. This would be things like PEG feeds (?).

That is the general idea. Basically where you need hospital type/nursing care, but can be managed in the home.
Setting up drips, regular injections, high level of pain relief, managing a tracheostomy  etc .
You can have a very high level of disability, illness, but if you do not need this regular medical attention you will not get CHC funding.
Clearly there will be some grey areas where is more 50:50.

elsien

itsthelittlethings said:

Continuing Healthcare funding is for people whose needs are purely health in my understanding ie they really need to be cared for in a hospital long term. This would be things like PEG feeds (?).

a peg feed in and of itself would not qualify for full health funding. people can have peg feeds in their own home with no nursing input, or just the district nurses occasionally. Full CHC funding is tied into the intensity and the complexity of the need.

Rubyroobs

It doesn't sound like he meets the criteria for CHC. As others have said it's about needing medical/ Nursing care so things like TPN, Tracheostomy care, suctioning/ complex behavioral needs  etc. It is very hard to get. The only people I've known get some CHC funding recently has been for palliative care and TPN ( and that was only for an hour or so a day whilst it was set up ). If his care can mainly be managed by non medical care then he is unlikely to qualify. 

Grey_Critic

Big difference between being in a home and being in your own home. The care home have staff who supervise the patients all the time - not being flippant but think of it as driving a car. The passenger chats away and looks around - the driver is constantly watching the road and looking out for possible problems. Two people in the car but two levels of awareness. the driver does their job even though tha passengers with their chatter can be a distraction. As carer for my wife I try to keep a close watch but she still managed to get cuts and bruises - when I am cooking she often obstructs me without realising. Got a hot dish in my hands and instead of moving out of the way she will ask me what I am going to do with it instead of getting out of the way. She does not see a problem  - she used to.

EnPointe

itsthelittlethings said:

Continuing Healthcare funding is for people whose needs are purely health in my understanding ie they really need to be cared for in a hospital long term. This would be things like PEG feeds (?).

A lot of peopel  seem to think that CHC is magic bullet for care funding,  where the reality as you  correctly state is that if  there CHC funding was  not made available the individual would  require hospital care, as their care needs  exceed the funding and resourcing  of  typical 'Care Home with Nursing '  that would  attract the Nursing care  funding  contribution